tbuckley/cabot-search huggingface dataset:
Abstract 9409: Risk Factors and Outcomes Associated With Loss of Follow-Up in Children With Congenital Heart Disease
Authors: Michael B Rosamilia, Jason Williams, Courtney A Bair, Hillary Mulder, Karen Chiswell, Alfred DOttavio, Tracy G Spears, Robert J Hartman, Charlie J Sang, Karl F Welke, Michael J Walsh, Timothy M Hoffman, Andrew P Landstrom, Jennifer S Li, Lauren A Sarno
Journal: Circulation (2022)

Introduction: Adults with congenital heart disease (CHD) benefit from cardiology follow-up. However, benefit for children is less clear as studies of follow-up patterns in children with CHD are limited. Hypothesis: There are identifiable risks for loss to cardiology follow-up in children with CHD, and loss to follow-up changes healthcare utilization and outcomes. Methods: Our cohort included children &lt;10 years old with CHD and a healthcare encounter from 2008 to 2013 at one of four North Carolina hospitals. Using a Cox proportional hazards model, we assessed associations between demographics, presence of a severe lesion (conotruncal, endocardial cushion, and single ventricle lesions, aortic arch interruption, and total anomalous pulmonary venous return), and healthcare access, including educational isolation (EI) via geo-coded neighborhood of residence, and at least one cardiology follow-up visit within two years of initial encounter. We analyzed healthcare utilization by follow-up using a negative binomial landmark analysis. We described incidence of death and cardiac transplantation. Results: Of the 6,969 children, 24.8% were non-Hispanic Black and 14.1% were Hispanic. Overall, 60.4% received follow-up within 2 years, including 53.1%, 58.1%, and 79.0% of those with valve, shunt, and severe lesions respectively. Factors associated with loss to follow-up were increased drive time to the nearest cardiology clinic (Hazard Ratio 0.92 per 15-minute increase), EI (HR 0.94 per 0.2-unit increase), lower lesion severity (HR 0.48 for shunt/valve vs severe), and older age at initial encounter (HR 0.95 per month if &lt;1 year old and 0.94 per year if &gt;1 year old; p&lt;0.05 ). Children lost to follow-up had more emergency department (ED) visits (Rate Ratio 1.59) and fewer inpatient encounters and procedures (RR 0.51, 0.35; p&lt;0.05 ). Only 0.8% of children died or received a cardiac transplant after the 2-year landmark with no significant difference between follow-up groups. Conclusions: We found novel factors associated with loss to cardiology follow-up in children with CHD and worse utilization with loss to follow-up. Our findings demonstrate a need to mitigate healthcare barriers and generate clear cardiology follow-up guidelines for children.
Abstract 9330: Improving Knowledge, Competence, and Confidence of Physicians Related to Antithrombotic Therapy in Cardiovascular Disease With Curriculum-Based Online Education
Authors: Margaret Harris, Michael Lacouture
Journal: Circulation (2022)

We sought to determine if a curriculum of online continuing medical education (CME) activities presented in multiple delivery formats could improve the clinical knowledge, competence, and confidence of cardiologists related to the use of antithrombotic therapy in patients with chronic CAD, PAD, and VTE. The curriculum consisted of 13 online, CME-certified activities in multiple delivery formats. Education effect was assessed with a repeated pairs pre-/post-assessment study including a 3-item, multiple choice, knowledge/competence questionnaire and one confidence assessment question, with each participant serving as his/her own control. To assess changes in knowledge, competence, and confidence data from all clinicians who completed both pre- and post-questions were aggregated across activities and stratified by learning theme. McNemar’s test or paired samples t-test (P &lt;.05) assessed educational effect. The activities launched from March 24, 2021 to August 2, 2021 and data were collected for up to 12 weeks for each activity. The education reached 4,847 cardiologists. Overall, there were significant relative improvements in knowledge/competence (35%, P &lt;.001). related to understanding of recent clinical trial data regarding the use of antithrombotic therapy in patients with chronic CAD/PAD, understanding of the latest guideline-based recommendations for the use of antithrombotic therapy in patients with chronic CAD/PAD, understanding of the latest guideline-based recommendations for VTE prophylaxis in hospitalized medically ill patients, tailoring antithrombotic therapy in patients with chronic CAD/PAD, and individualizing VTE prevention strategies in hospitalized medically ill patients. Pre-vs-post gains in confidence were seen for tailoring antithrombotic therapy in patients with chronic CAD/PAD (50% improvement, P &lt;.001); Individualizing VTE prevention strategies in hospitalized medically ill patients (83% improvement, P &lt;.001). The online, CME-certified curriculum resulted in significant gains in knowledge/competence and confidence among cardiologists. These results demonstrate the effectiveness of curriculum-based education designed to address specific gaps in care.
Abstract 301: RescueDoppler: Non-invasive Handsfree Carotid Doppler Ultrasound For Continuous Hemodynamic-guided Resuscitation
Authors: Bjoern O Faldaas, Erik W Nielsen, Benjamin S Storm, Knut Tore Lappegård, Ole-Jakob How, Bent Aksel Nilsen, Gabriel Kiss, Eirik Skogvoll, Hans Torp, Charlotte B Ingul
Journal: Circulation (2022)

Introduction: Intermittent carotid pulse palpation (PP) is used to determine the return of spontaneous circulation (ROSC) during cardiopulmonary resuscitation (CPR). PP requires interruption of CPR and has low accuracy. Therefore, we investigated if a novel continuous non-invasive hands-free Doppler ultrasound system (RescueDoppler; RD) could detect the presence of pulse/no pulse and ROSC in an experimental setting with ventricular fibrillation (VF) and severe hypotension. Methods: RD was attached to the neck with a self-adhesive bandage onto twelve pigs (mean weight of 30.4 kg). RD used multirange Doppler, with 32 depth ranges over 8 - 45 mm. The transducer dimension was 30 x 6 mm. The RD probe was placed over the carotid artery, while invasive blood pressure was recorded on the contralateral side. Two profound circulatory disturbances were initiated; 1) severe hypotension by vena cava inferior occlusion (VCO) using a 7 Fr Fogarty catheter with gradual balloon inflation and 2) VF by applying a 7.5 V direct current in the myocardium for 2 seconds using an implantable cardioverter-defibrillator placed in the right ventricle apex. The pigs were defibrillated back to ROSC. Mean velocity over one cardiac cycle (time-averaged velocity; TAV) was compared with mean arterial pressure (MAP). Results: RD detected flow in the carotid artery in all 41 VCO sequences (figure), including the lowest induced systolic blood pressure of 19 mmHg. The intraclass correlation coefficient was 0.76 between TAV and MAP. ROSC was equally identified by RD and invasive blood pressure in all 21 VF sequences where the pigs were defibrillated from VF to sinus rhythm (figure). Conclusion: The RD system was simple and required no ultrasound knowledge. RD detected ROSC and blood flow at extremely low invasive carotid blood pressures during VF and VCO. TAV correlated well with MAP. RD could become an essential non-invasive, hands-free tool for continuous hemodynamic-guided CPR.
Abstract 331: Impact Of Concomitant Use Of Veno-arterial Extracorporeal Membrane Oxygenation And Impella Support On Short-term Mortality In Acute Coronary Syndrome Patients With Refractory Cardiogenic Shock
Authors: Yuta Tsurusaki, Takashi Unoki, Tomoko Nakayama, Junya Matsura, Takaaki Toyohuku, Yutaka Konami, Hiroto Suzuyama, Masayuki Inoue, Eiji Horio, Tetsuo Yufu, Kazuhisa Kodama, Megumi Yamamuro, Eiji Taguchi, Tadashi Sawamura, Koichi Nakao, Tomohiro Sakamoto
Journal: Circulation (2022)

Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is one of effective therapeutic modalities for patients with cardiogenic shock (CS) and acute coronary syndrome (ACS). While VA-ECMO maintains end-organ perfusion, it increases damaged left ventricular (LV) wall tension. Combined treatment of VA-ECMO and a micro-axial Impella pump, referred to as ECPELLA, simultaneously provides systemic circulatory support and LV unloading. However, it remains unknown whether LV unloading effect on ECPELLA support further reduces mortality compared to currently available VA-ECMO+IABP support. Purpose: Investigate whether ECPELLA can reduce mortality in ACS patients with severe cardiogenic shock who required VA-ECMO. Methods: From January 2012 to May 2022, 100 consecutive patients with ACS and CS who received VA-ECMO before or after percutaneous coronary intervention were enrolled. Patients were divided into two groups; 39 patients in the ECPELLA; and 61 patients in the VA-ECMO with IABP. We assessed peak serum CPK-MB levels and 30-day mortality. Results: There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, left main trunk (LMT) lesion, multi-vessel disease (MVD), number of coronary lesions, extracorporeal cardiopulmonary resuscitation, and the time from onset to reperfusion between two groups. The ECPELLA had lower peak CPK-MB levels compared to VA-ECMO with IABP, but the difference did not reach statistical significance (p=0.056). Kaplan-Meier analysis revealed that the ECPELLA had significantly lower 30-day mortality ( p=0.0016 ). Multivariable Cox proportional hazard analysis revealed that ECPELLA (HR: 0.22 95% confidence interval:0.11-0.45; p&lt;0.0001) was inversely and independently associated with 30-day all-cause mortality. Conclusion: ECPELLA treatment appeared to have advantage in reduction of 30-day mortality.
Abstract 316: Ultra-early Diffusion-weighted Magnetic Resonance Imaging For Assessment Of Prognosis In Out-of-hospital Cardiac Arrest Survivors
Authors: Jinhong Min, Jung Soo Park, Yong In, Yeon Ho You, Changshin Kang
Journal: Circulation (2022)

Aim: We investigated the association of poor neurological outcomes with ultra-early diffusion-weighted magnetic resonance imaging (DW-MRI) of the brain in out-of-hospital cardiac arrest (OHCA) survivors and how to complement for false-negative findings (FNF). Methods: This registry-based observational study included adult comatose OHCA survivors who underwent DW-MRI scans within 6 h after the return of spontaneous circulation (ROSC). This study was divided into four groups: Group A (poor outcome with high-signal intensity (HSI) on DW-MRI), Group B (poor outcome without HSI [FNF]), Group C (good outcome without HSI), and Group D (good outcome with HSI). We analyzed serum and CSF neuron-specific enolase (NSE), albumin quotient (albumin CSF /albumin serum ) (Qa), apparent diffusion coefficient (ADC) value, and low flow time, among others, obtained within 6 h after ROSC. The primary outcome was the 3-month poor (CPC 3-5) outcome. Results: Of the 110 patients, 62 (56.4%) had poor outcomes, time from ROSC to MRI was 2.8 h (IQR, 2.0-4.0 h), and HSI on DW-MRI was observed in 46 (41.8%). The composition of Groups A, B, C, and D was 46 (41.8%), 16 (14.5%), 48 (43.6%), and 0 (0%) patients, respectively. Group B had significantly lower serum NSE, 650 ADC value, Qa, and low flow time than Group A; however, CSF NSE was higher than in Group C (Fig. 1). DW-MRI and CSF NSE identified patients with poor outcomes with 74.2% sensitivity (95% CI 61.5-84.5) and 100% specificity (95% CI 92.6-100), and 67.9% sensitivity (95% CI 53.7-80.1) and 100% specificity (95% CI 90.3-100), respectively. Combining the two tools increased identification to 87.1% sensitivity (95% CI 76.1-94.3) at 0% false positive rate (FPR). Conclusions: The HSI on ultra-early DW-MRI in OHCA survivors was significantly associated with poor outcomes. The CSF NSE is a complementary tool showing higher sensitivity at 0% FPR than DW-MRI alone. Multicenter prospective studies are required to determine the results’ generalizability.
Abstract 289: Temporal Trends In The Incidence And Outcomes Of In-hospital Cardiac Arrest In Patients Hospitalized With Liver Cirrhosis In The Us: Analysis Of The Nationwide Inpatient Sample From 2010-2019
Authors: Titilope Olanipekun, Abimbola Chris-Olaiya, Abhishek Bhardwaj, Temidayo Abe, Valery S Effoe, Aanchal Kapoor
Journal: Circulation (2022)

Introduction: Liver cirrhosis affects an estimated 1 in 400 adults in the US with significant morbidity and mortality. There is limited data on the incidence and outcomes of in-hospital cardiac arrest (IHCA) in liver cirrhosis-related hospitalizations. Methods: Using the appropriate international classification of disease codes, we queried the nationwide inpatient database to identify patients hospitalized with a primary diagnosis of liver cirrhosis who experienced IHCA and underwent cardiopulmonary resuscitation, between 2010 and 2019, We evaluated the temporal trends in the in-hospital outcomes using Cochrane -Armitage test, and factors associated with survival to hospital discharge using logistic regression analysis. Results: 7,091,054 weighted liver cirrhosis hospitalizations were identified during the study period. The IHCA incidence rate was 1.4% with a mean age (SD) of 59 years (12) and males were predominantly affected (59.9%). There was an upward trend in IHCA incidence during the study period (1.3% in 2010 to 1.5% in 2019, p &lt; 0.001). The overall survival to hospital discharge rate was 22.2%. No significant change in the mortality trend during the study period. Most of the survivors were discharged to a long-term acute care facility (46.4%) followed by home discharge without the need for home health (24.7%) and short-term acute facilities (12.6%). Factors associated with lower odds of survival to hospital discharge were age &gt; 65 years OR 0.71, 95% CI 0.67 - 0.75, P &lt; 0.001), Black (OR 0.94, 95% CI 0.91 - 0.99, P=0.012) and Hispanic race (OR 0.78, 95% CI 0.74 - 0.81, P &lt; 0.001), and severe comorbidity index (OR 0.63, 95% CI 0.59 - 0.65, P &lt; 0.001). Conclusion: Between 2010 and 2019, we found a slight increase in the IHCA incidence rate among patients hospitalized with liver cirrhosis. Only about one out of 5 patients survived hospital discharge, and this did not change during the study period. Low socioeconomic status and higher comorbidity burden were associated with lower odds of survival. More research is needed to identify strategies that may improve survival outcomes in IHCA among liver cirrhosis patients.
Abstract 9486: miR-425/CFL2 Regulates Natriuretic Peptides Expression in Human CVD
Authors: Yang Chen, Xiao Ma, Seethalakshmi R Iyer, Shawn Reginauld, Jeson Sangaralingham, John C Burnett
Journal: Circulation (2022)

Introduction: Previously, miR-425 have been implicated in the inhibition of the cardiac natriuretic peptide (NP) ANP gene expression with their role on BNP undefined. The mechanism by which miR-425 modulates NP expression remains to be explored. In heart failure (HF), adrenergic and neurohormone pathways are aberrantly activated. Our goal was to investigate the role of miR-425 and its downstream target Cofilin 2 (CFL2) on ANP and BNP expression in human CV disease (CVD). Hypothesis: We hypothesized miR-425, via CFL2, supresses NPs expression in vitro. MiR-425, CFL2 and NP levels were also determined in CVD patients. Methods: In vitro, human cardiomyocytes (HCM) were treated with vehicle (Veh), catecholamine isoproterenol (ISO) and cytokine endothelin (ET), miR-425 mimic. Cells were transfected with CFL2 plasmid or CFL2 siRNA. Normal (NM, n=100), Hypertension (HTN, n=30) and Acute HF (AHF, n=74) cohorts were studied. A confirmatory cohort was recruited. Plasma NT-proBNP, miR-425 were measured. In left ventricles (LV) from NM or HF (n=5 each), NP, CFL2 and miR-425 expression were assessed. Data expressed as means±SEM. * p&lt;0.05 vs NM or Veh. Results: In vitro in HCM, treatment with ISO or ET in HCM reduced miR-425 and elevated NP mRNA levels. Furthermore, miR-425 mimic reduced Nppa (Veh: 1.0±0.03, mimic: 0.7±0.02*) and Nppb levels (Veh: 1.0±0.03, mimic: 0.5±0.01*). We showed that a top predicted target of miR-425, CFL2, was also reduced by the mimic. Further, NP mRNA was elevated by CFL2 overexpression and reduced by the knockdown of CFL2. In humans, MiR-425 was lower in HTN and AHF patients (NM: 0.15±0.03, HTN: 0.03±0.005*, HF: 0.01±0.003*) than NM. MiR-425 negatively correlates with NT-proBNP in NM and AHF cohorts. Downregulation of miR-425 was validated in a second AHF cohort. Similarly, in HF LV tissues, miR-425 (NM: 2.5±0.5, HF: 1.0±0.5*) was lower than NM group, while CFL2 and NP gene and protein expression were increased. Conclusion: In vitro, cardiac stress hormones downregulate miR-425 and increase NP gene expression, potentially through a novel target, CFL2. In CVD patients, miR-425 is lower, accompanied by an elevation of CFL2 and NP. Our findings implicate the pathway of stress hormones/miR-425/CFL2/NP production in CVD.
Abstract 9495: Deep Learning Algorithm for Predicting Atrial Fibrillation Based on Chest Radiography
Authors: Yujeong Kim, SungA Bae, Dukyong Yoon
Journal: Circulation (2022)

Introduction: Atrial fibrillation (AF) is a common risk factor for stroke and heart failure, with gradually increasing prevalence. AF is usually diagnosed on the basis of electrocardiography. Chest radiography is commonly performed as a screening test among patients with cardiac diseases but cannot be used to detect AF because of its unclear radiographical findings.Hypothesis: We hypothesize that deep learning methods, particularly convolutional neural networks (CNN), can be used to detect AF on chest radiographs. Methods: Chest radiographs used for training were obtained from Yongin Severance Hospital, South Korea. A total of 11,044 images acquired from patients with normal sinus rhythm or AF were used, whereas images from patients with other rhythms, such as paced rhythm or left bundle branch block, were excluded. The training, validation, and test datasets were split 8:1:1, and Resnet was applied as a model architecture. The accuracy, area under the receiver operating characteristic (ROC) curve, area under the precision-recall curve (PRC), precision, and recall were calculated. Gradient-weighted class activation mapping (Grad-CAM) was used to determine the area focused on by the model to predict AF. Results: AF was detected from chest radiographs with an accuracy, AUC, and PRC of 0.95, 0.81 and 0.39 in the validation set, respectively, and 0.94, 0.76, and 0.35 in the test set, respectively (Figure 1-A, B). Grad-CAM showed that the highest predictive value images from each dataset focused on the heart and its border, while the lowest predictive value images focused on the ribs (Figure 1-C, D, E, F). Conclusions: Deep learning algorithms can be used to detect AF on chest radiographs, which can be used as a screening tool for AF patients.
Abstract 335: Hsf1 Regulates Exosome Biogenesis And Cargo Enrichment Of These Exosomes In Stem Cells Thereby Enhancing Their Potential Of Ischemic Heart Regeneration.
Authors: Sameer A Guru, Progyaparamita Saha, Muthukumar Gunasekaran, Ling Chen, Sudhish Sharma, Xuebin Fu, Swetha Krishnan, Anshuman Sinha, Sunjay Kaushal, Rachana Mishra
Journal: Circulation (2022)

Introduction: Paracrine mechanism of stem cell-based therapy holds importance. However, genes regulating the paracrine factors have not been elucidated in detail. Here in this study, we evaluated the role of HSF1 in exosome biogenesis and their composition in neonatal cardiac mesenchymal stem cells (nMSCs) in concert with ischemic heart generation. Hypothesis: HSF1 in nMSCs promotes production of exosomes, functional exosomal miRs cargo, and exosome acquisition by recipient cells. Methodology: nMSCs and adult MSCs (aMSCs) were respectively isolated from right atrial appendage of neonate (&lt;1month) and adult ( &gt; 40 years) patients. nMSCs were knocked down (KD) for HSF1 gene using CRISPR-CAS9 technique while HSF1 gene was overexpressed (OE) in aMSCs using HSF1 overexpressing lentiviral constructs. Exosome biogenesis was evaluated using nano site technique. We next evaluated effect of HSF1 KD and OE on miRs cargo in nMSCs and aMSCs respectively. Exosome acquisition by target cells was studied by mCherry labeling technique. The potential of nMSCs and aMSCs and their corresponding exosomes to repair rat ischemic heart was evaluated under the effect of HSF1 KD and OE. Results: HSF1-KD in nMSCs resulted in significant reduction in production of exosomes, downregulation of ESCRT complex genes and therapeutic miRs viz, miR-199a, mi590-3P and miR-146. In contrast, HSF-1 over expression in aMSCs statistically increased production of exosomes, ESCRT complex genes and of therapeutic miRs. Moreover, HSF-1 OE in aMSCs resulted in statistical downregulation of miR-122, known to induce apoptosis, and downregulation of p27, a known target of miR-590. We identified that potential of nMSCs to repair ischemic heart decreased statistically after HSF1-KD while that of aMSCs increased significantly after HSF1-OE. Finally, we identified exosomes from these stem cells were preferentially taken up by cells in injured myocardium and not by cells in non-injured one and that HSF1-OE increased the uptake by recipient cells while HSF1-KD had opposite effect. Conclusion: Together, our results demonstrate that HSF-1 plays an important role in exosome biogenesis, miRs cargo enrichment and uptake of exosomes by recipient cells.
Abstract 287: Trends In Cardiac Arrest Outcomes In Children With Cardiac Disease: An Analysis From The Aha Get With The Guidelines <sup>®</sup> Database
Authors: Monique M Gardner, Ryan W Morgan, Ron Reeder, Kimia Ghaffari, Laura Ortmann, Tia T Raymond, Javier J Lasa, Jessica Fowler, Maya Dewan, Vinay M Nadkarni, Robert A Berg, Robert M Sutton, Alexis A Topjian
Journal: Circulation (2022)

Introduction: Contemporary rates of survival after pediatric in-hospital cardiac arrest (IHCA) and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that (1) survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and (2) rates of survival after IHCA increased over time in all categories. Methods: The AHA Get With The Guidelines ® -Resuscitation database was queried for index IHCA events (excluding delivery room and neonatal intensive care unit) in children &lt;18 years of age from 2000-2021. Categories were defined as: surgical-cardiac, IHCA following cardiac surgery; medical-cardiac, IHCA in non-surgical cardiac disease; and non-cardiac, IHCA in patients without cardiac disease. The primary outcome was survival to hospital discharge. We compared eras 2000-2004, 2005-2009, 2010-2014, and 2015-2021 with mixed logistic regression models, including event year as a continuous predictor and site as a random effect. Results: Of 17,696 index events, IHCA by illness category were: 18% surgical-cardiac, 18% medical-cardiac, and 64% non-cardiac. Surgical-cardiac category had the highest rate of survival to discharge compared to medical-cardiac and non-cardiac categories (56.1% vs. 43.4% vs. 46.3%; p&lt;0.001). After controlling for age, location of event, and hospital size, the odds of survival were higher for surgical-cardiac category (aOR 1.28 (1.16, 1.40)) and lower for medical-cardiac category (aOR 0.87 (0.80, 0.95)), compared to the non-cardiac category. Odds of survival increased for all illness categories across eras. Between the 2000-2004 and 2015-2021 eras, survival in surgical-cardiac subjects increased from 45.6% to 62.3% with odds of survival increasing by 24% per era, (OR 1.24 (95% CI 1.15, 1.35), and survival for medical-cardiac subjects increased from 36.6% to 47.0%, with 14% increased odds per era (OR 1.14 (1.06, 1.23)). Conclusions: Over the last 20 years, children with surgical-cardiac IHCA have substantially higher odds of survival to hospital discharge compared to non-cardiac IHCA categories, whereas odds of survival were worse with medical-cardiac IHCA. Survival to hospital discharge has increased in all IHCA illness categories.